LiveCareer-Resume

dsnp navigator compliance champ team lead resume example with 8+ years of experience

JC J S S JS J S S JS J S S JS J S S JS J S S JS J S S JS
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

Member-focused DSNP Nav and Team lead equipped with administrative and customer service expertise. Help keep healthcare services proceeding smoothly by coordinating communications, referrals and policy enforcement. Talented in finding balanced solutions and resolving conflicts.

Focused Compliance Champ dedicated to maintaining company compliance with all relevant requirements. Proficient in reviewing internal controls, processes and procedures. Skilled in excel, outlook, Microsoft word, Power point.

Monitor and supervise team to achieve goals that contribute to the growth of the organization. Provide guidance , instructions , direction and leadership to the team in order to achieve maximum results as a whole.

Skills
  • Customer service
  • Regulatory documentation
  • Compliance review/Oversight
  • Regulatory compliance review
  • Investigative skills
  • Risk management strategies
  • Data evaluation
  • Reporting requirements
  • System management
  • Troubleshooting
  • Document analysis
  • Excel
  • Microsoft Office
  • Powerpoint
  • Outlook
  • Qualtric
  • Qfiniti
  • Sharepoint
  • Maestro
  • MyMetrics
  • I-CUE
  • Genesys
  • VCC
  • IEX
  • FACETS
  • GPS
  • I-SET
  • HAWKEYE(House call appointment scheduling)
Experience
02/2020 to Current DSNP Navigator/ Compliance Champ/Team Lead Fairmount Santrol | Fort Smith, AR,
  • Provide concierge and white-glove level service, removing burdens and providing end-to- end resolution for members.
  • Delivered fast, friendly and knowledgeable service for routine questions and service complaints
  • Provided outstanding service to new and long-standing members by attending closely to concerns and developing solutions.
  • Asked probing questions to determine service needs and accurately input information into system.
  • Serve as a single point of contact for the members and form a strong relationship to support them.
  • Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.
  • Research complex issues across multiple databases and work with support resources to find the resolution of all member issues and anticipate their future healthcare needs or potential opportunities to improve the experience.
  • Respond to and resolve consumer inquiries and issues.
  • Conduct proactive research on assigned member accounts to identify service issues.
  • Identify gaps in processes and work closely with other departments for process improvement.
  • Provide education and status on previously submitted pre-authorizations or pre- determination requests.
  • Meet the performance goals established for the position in the areas of: efficiency, call quality, member satisfaction, first call resolution and attendance.
  • Produced reports detailing compliance findings and recommendations for improvements.
  • Provided compliance risk control consultation to leadership and team.
  • Assessed internal documentation and communications as well as public relations and materials for compliance with company policies and requirements.
  • Assist and educate Team in resolving any member related issues they may have . Whether its with compliance , billing issue, Turn around times, Finding providers, assisting with resolutions to meet member satisfaction.
03/2018 to 02/2020 M&R Customer Service Advocate Fairmount Santrol | Guion, AR,
  • Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
  • Respond to and resolve, on the first call, member service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence.
  • Help guide and educate members about the fundamentals and benefits of member-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider.
  • Contact care providers (doctor's offices) on behalf of the member to assist with appointment scheduling or connections with internal specialists for assistance.
11/2016 to 01/2018 Customer Service Representative Dynamic Auto Movers | City, STATE,
  • Answered Customers questions and addressed problems and complaints in person and via phone
  • Transferred calls, Opened and closed the office which included all bank deposits were accountable and made sure all charges that needed to be done for the day were done
  • Payroll must be done weekly every Thursday.
  • All paychecks made out and handed out to the employees every Friday.
  • Upheld quality control policies and procedures to increase customer satisfaction.
  • Audited customer account information to identify issues and develop solutions.
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
  • Made outbound calls to obtain account information.
06/2013 to 11/2016 Customer Service Representative All American Transport | City, STATE,
  • Answered Customers questions and addressed problems and complaints in person and via phone.
  • Transferred calls, Opened and closed the office which included all bank deposits were accountable for and made sure all charges that needed to be done for the day were done.
  • Fielded customer complaints and queries, fast-tracking them for problem resolution.
  • Upheld quality control policies and procedures to increase customer satisfaction.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Consulted with customers to resolve service and billing issues.
  • Made outbound calls to obtain account information.
  • Answered incoming telephone calls to provide store, products and services information.
  • Answered inbound calls, chats and emails to facilitate customer service.
Education and Training
Expected in 06/2008 to to High School Diploma | Miami Senior High School, Miami, FL GPA:
Expected in to to Associate of Arts | Crime Scene Tech FNU, Miami, FL, GPA:

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • Miami Senior High School
  • FNU

Job Titles Held:

  • DSNP Navigator/ Compliance Champ/Team Lead
  • M&R Customer Service Advocate
  • Customer Service Representative
  • Customer Service Representative

Degrees

  • High School Diploma
  • Associate of Arts

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: